Alcohol Control Efforts in Comprehensive Cancer Control Plans and Alcohol Use Among Adults in the USA

Alcohol and Alcoholism Vol. 49, No. 6, pp. 661–667, 2014 Advance Access Publication 13 October 2014 doi: 10.1093/alcalc/agu064 Alcohol Control Efforts in Comprehensive Cancer Control Plans and Alcohol Use Among Adults in the USA S. Jane Henley1, *, Dafna Kanny2, Katherine B. Roland1, Melissa Grossman1,†, Brandy Peaker1,†, Yong Liu2, Susan M. Gapstur3, Mary C. White1 and Marcus Plescia1,† 1 Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA, 2Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA and 3Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA *Corresponding author: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Bldg 107, Mail Stop F-76, Atlanta, GA 30341, USA. Tel.: +1-770-488-4157; E-mail: (Received 12 June 2014; in revised form 15 August 2014; accepted 18 August 2014) Abstract — Aims: To understand how US cancer control plans address alcohol use, an important but frequently overlooked cancer risk factor, and how many US adults are at risk. Methods: We reviewed alcohol control efforts in 69 comprehensive cancer control plans in US states, tribes and jurisdictions. Using the 2011 Behavioral Risk Factor Surveillance System, we assessed the prevalence of current alcohol use among US adults and the proportion of these drinkers who exceeded guidelines for moderate drinking. Results: Most comprehensive cancer control plans acknowledged alcohol use as a cancer risk factor but fewer than half included a goal, objective or strategy to address alcohol use. More than half of US adults reported current alcohol use in 2011, and two of three drinkers exceeded moderate drinking guidelines at least once in the past month. Many states that did not address alcohol use in comprehensive cancer control plans also had a high proportion of adults at risk. Conclusion: Alcohol use is a common cancer risk factor in the USA, but alcohol control strategies are not commonly included in comprehensive cancer control plans. Supporting the implementation of evidence-based strategies to prevent the excessive use of alcohol is one tool the cancer control community can use to reduce the risk of cancer. INTRODUCTION Each year in the USA, excessive alcohol use is responsible for ~88,000 premature deaths (Centers for Disease Control and Prevention, 2013). In 2006, excessive alcohol use was estimated to cost the USA about $224 billion in lost productivity, health care expenditures, criminal justice system costs and motor vehicle crashes (Bouchery et al., 2011). Additionally, alcohol use is causally related to several cancers, including cancers of the oral cavity, pharynx, larynx, esophagus, liver, colon, rectum and breast (International Agency for Research on Cancer, 2010; Parkin, 2011). A recent study estimated that 3.2–3.7% (18,200–21,300) cancer deaths in the USA in 2009 can be attributed to alcohol (Nelson et al., 2013). Cancer risk increases with the amount of alcohol consumed for many types of cancer, and even a few drinks a week may be harmful for some cancers (Boffetta and Hashibe, 2006; Parkin, 2011; Pelucchi et al., 2011). Although the potential to prevent cancer by reducing alcohol use is recognized within the public health community (Institute of Medicine, 2003; Frieden et al., 2008), data from the 2003 Health Information National Trends Survey found that only 11% of US adults stated that limiting alcohol intake could prevent cancer (Hawkins et al., 2010). The 2010 US Dietary Guidelines recommend that those who drink alcohol should do so in moderation, defined as no more than one drink a day for women and no more than two drinks a day for men (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010). Several public health organizations have issued guidelines or recommendations to prevent alcohol misuse and promote healthy environments (World Health Organization, 2010; National † Affiliation where research was done. Prevention Council, 2011; Guide to Community Preventive Services, 2012; Moyer, 2013). One objective of this study was to examine the extent to which alcohol control efforts, in the context of cancer prevention, are being implemented in comprehensive cancer control plans. A second objective was to examine the prevalence of current alcohol use among US adults, categorized by adherence to the 2010 US Dietary Guidelines. METHODS Through the National Comprehensive Cancer Control Program (NCCCP), the Centers for Disease Control and Prevention (CDC) funds all 50 states, the District of Columbia, seven tribal governments, and seven territories and jurisdictions to establish coalitions of public and private stakeholders, assess the burden of cancer, determine priorities, and develop and implement cancer plans (Given et al., 2005). One of the grantees, the Federated States of Micronesia, supports four Micronesian states, each of which submits a cancer plan to CDC. So, in total, there are 69 comprehensive cancer control plans. During January–May 2013, we reviewed the most recent comprehensive cancer control plan from each program, including 52 plans posted on the Cancer Control P.L.A.N.E.T. website (http://cancercontrolplanet.cancer.gov/) and 17 plans that were updated but not yet posted on the Cancer Control P.L.A.N.E.T. website. At this time plans spanned 1–10 year periods from 2003 through 2020. In comprehensive cancer control plans, a goal refers to a specific program achievement within a specified time period; an objective refers to efforts undertaken to achieve that goal; and a strategy or tactic refers to specific activities needed to achieve that goal. The keyword ‘alcohol’ was used to search all plans, and content containing the term ‘alcohol’ was Published by Oxford University Press on behalf of Medical Council on Alcohol 2014. Downloaded from https://academic.oup.com/alcalc/article-abstract/49/6/661/2888172 This work is written by (a) US Government employee(s) and is in the public domain in the US. by guest on 03 May 2018 662 Henley et al. abstracted and reviewed. First, the plan was evaluated to determine if alcohol use was included as a cancer risk factor in the background information. Next, plans were classified as to whether alcohol use was addressed as a risk factor in at least one goal, objective or strategy. Then relevant goals, objectives and strategies were classified as pertaining to one or more of the following categories: raising public awareness of cancer risk associated with alcohol use, educating individuals about cancer risk associated with alcohol use; reducing prevalence of excessive alcohol use (categorized as measurable or nonmeasurable (...truncated)